Healthcare Provider Details

I. General information

NPI: 1265765614
Provider Name (Legal Business Name): AMY DITTMER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 HENNEPIN AVE N
GLENCOE MN
55336-1416
US

IV. Provider business mailing address

1805 HENNEPIN AVE N
GLENCOE MN
55336-1416
US

V. Phone/Fax

Practice location:
  • Phone: 320-864-7825
  • Fax:
Mailing address:
  • Phone: 320-864-7825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number119702
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: